The future of medical education

Zeke Emanuel speaking at the Pediatric Innovation Summit.

One of the other very enjoyable and provocative presentations at the Pediatric Innovation Summit in October was the one by Zeke Emanuel on the future of medicine in the era of the Affordable Care Act. Emanuel was involved in the drafting of that legislation and provided significant insight into the thinking that went into the bill. While the jury is still out on how effective the ACA will ultimately be, his speech gives one hope that legislation can still be a thoughtful process capable of generating positive result. Near the end of his presentation, he discusses six megatrends that will affect medicine in the coming decades, including changes to medical education. The presentation draws from his recent book, Reinventing American Health Care, which the presentation sold me on and I highly recommend if you want to understand the ACA.

In the book, he shares his view that medical training will go from four years to three, and will move from being based in hospitals to including training in practices, patient homes clinics and other settings that will increasingly become the settings for care. He discussed how this will impact teaching, forcing medical school faculty to be more flexible in the ways they provide education to students in these distributed environments:

Educators will need to devote more time and resources to cultivating training sites outside of the hospital for students as well as interns and residents, including doing house calls and working in other facilities. In addition, they will need to develop more formalized curricula for training at these sites so as to ensure students learn the full range of lessons. They will also need to develop appropriate faculty who can teach in these new training sites. This may seem easy, but it is not. Office and clinic time is heavily booked, without set periods for student learning. Educators will need to work with physician practices to make them teaching practices.

Interestingly, though, while he discusses the challenges of teaching in these physical spaces—and inasmuch as the rest of the book focuses on new technologies like electronic medical records—he completely misses the increasingly important role that learning in digital spaces like OPENPediatrics will assume. Especially as limits on service hours also affect the time students can spend in these distributed settings, formal learning will have to be integrated and efficient, available on mobile devices in small, digestible chunks, and scalable. The new generation of learning technologies that are driving MOOCs and OPENPediatrics are ideal for this role.

I also feel he misses the importance of continuing education in the future of medical education. As medical school gets compressed, and the pace of discovery and innovation continues to accelerate, continuing education will become a necessity. And continuing education for practicing physicians and nurses will face many of the same time and location constraints as those he describes for medical school. Digital educational technologies will be the only practical method of providing meaningful ongoing education to practicing clinicians at scale.

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Commonplace books were a way in Early Modern Europe to compile knowledge. Such books were scrapbooks filled with medical recipes, quotes, letters, poems, tables of weights and measures, proverbs, prayers, legal formulas. Each book was unique to its creator's particular interests.